my boyfriend has been taking atripla since jan07 blood work from feb came back and his md told him that he is undectable this was over the phone unfortuanatly he didnt ask what does that mean i have read somethings but im confused and dont want to assume anything please explain what does that mean is that good news how can we keep it that way if possible?

Response from Dr. Sherer

It is important to understand the answer to this simple question.

First, it IS good news, and you are asking exactly the right question to ask how you and your boyfriend can keep his viral load below the level of detection.

Let's start with dispelling some myths:

1) An undetectable viral load does NOT mean you are cured from AIDS. There is no cure for HIV infection, which causes AIDS, but there is effective treatment that can last for months and years, even many years.

2) An undetectable viral load does NOT meant that you are no longer able to transmit the virus. There are documented cases in which a pregnant woman with an undetectable viral load has transmitted the virus to her baby, and there are documented cases in which a man with an undetectable viral load has transmitted the virus to his wife through unprotected vaginal intercourse (and the same for a woman to a man).

and 3) An undetectable viral load does NOT mean that the virus is 'gone' from your body. In fact the virus is still present in high volume in many tissues, even when it is undetectable in the blood.

An undetectable viral load DOES mean that the amount of viral particles of RNA in the blood stream are lower than the lower limit of our tests to detect them - usually expressed as "below 50 or 75 copies/ml".

This is a remarkable achievement of potent antiretroviral therapy, in that it can reduce the amount of such viral particles, which is called the 'viral load', from one million or more copies/ml to below 50 copies/ml in a short period, i.e. 6 months or less.

It is important to remember that antiretroviral therapy (ART) causes the virus to stop reproducing, but it does not kill the virus. Thus, if you stop taking your ART, or you take it improperly, it will resume replicating, and your viral load will again become detectable and rise to levels near the original level (i.e. before ART was begun).

And to go back to your question, it IS good news because we know that an undetectable viral load of <50 copies/ml is the best predictor of a durable response to ART.

The best way that your boyfriend can keep his viral load below detection is to take every dose of the ART as prescribed by his doctor, with no misses, i.e. to have excellent adherence.

And, if and when he lapses and forgets his medication, you and he would be smart to think about what happened and how to prevent a similar lapse in the future.

I urge you to take these answers to your simple question to your doctor, to ensure that you understand these answers, and to allow you to follow up with some additional answers of your own.

Finally, your boyfriend is lucky to have your interest and concern. There is evidence that a person with HIV has better adherence if they have a trusted friend or family member who knows their situation and who helps them to remain as close to perfectly adherent as possible.

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